Zou Yifeng, Chen Xi, Zhang Xinzhi, Shen Zhihong, Cai Jiawei, Tan Yingxin, Weng JingRong, Rong Yuming, Lin Xutao
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Int J Hyperthermia. 2020;37(1):944-954. doi: 10.1080/02656736.2020.1803424.
The optimal treatment for colorectal cancer (CRC) with synchronous peritoneal carcinomatosis (PC) and liver metastases (LM) remains controversial. We aimed to investigate clinical outcomes in patients with CRC and concomitant PC and LM who had undergone curative surgery, including resections at both metastatic sites and synchronous intraabdominal chemotherapy.
We searched PubMed, EMBASE, and Web of Science databases for eligible studies. Studies focusing on the clinical effects of curative surgery and synchronous intraabdominal chemotherapy for patients with CRC and concomitant PC and LM were included. Meta-analysis results were recorded as hazard ratios (HRs), risk ratios (RRs) and mean differences.
We included 9 of 998 identified studies in the meta-analysis, involving 746 patients (221 patients with PC + LM, 525 patients with PC). Overall survival (pooled HR 1.68, 95% confidence interval [CI] 1.33-2.13, < 0.01) and disease-free survival (pooled HR 1.82, 95% CI 1.51-2.20, < 0.01) were both lower in patients with PC + LM. A higher recurrence rate (RR 1.22, 95% CI 1.04-1.44, = 0.02) and major postoperative morbidity (RR 1.47, 95% CI 1.19-1.82, < 0.01) were also observed in patients with PC + LM.
Liver resection in combination with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for patients with CRC and synchronous hepatic and peritoneal metastases may be associated with worse survival and higher morbidity compared with patients with isolated PC. More restricted patient inclusion criteria should be established to facilitate an optimal prognosis for this patient group.
结直肠癌（CRC）合并同步性腹膜癌转移（PC）和肝转移（LM）的最佳治疗方案仍存在争议。我们旨在研究接受根治性手术（包括切除两个转移部位以及同步进行腹腔内化疗）的CRC合并PC和LM患者的临床结局。
我们在PubMed、EMBASE和科学网数据库中检索符合条件的研究。纳入关注根治性手术和同步腹腔内化疗对CRC合并PC和LM患者临床效果的研究。荟萃分析结果记录为风险比（HRs）、比值比（RRs）和均值差。
我们在荟萃分析中纳入了998项已识别研究中的9项，涉及746例患者（221例PC + LM患者，525例PC患者）。PC + LM患者的总生存期（合并HR 1.68，95%置信区间[CI] 1.33 - 2.13，P < 0.01）和无病生存期（合并HR 1.82，95% CI 1.51 - 2.20，P < 0.01）均较低。PC + LM患者还观察到更高的复发率（RR 1.22，95% CI 1.04 - 1.44，P = 0.02）和更高的术后主要发病率（RR 1.47，95% CI 1.19 - 1.82，P < 0.01）。
与单纯PC患者相比，CRC合并同步肝转移和腹膜转移患者行肝切除联合细胞减灭术及热灌注腹腔化疗可能与较差的生存率和较高的发病率相关。应制定更为严格的患者纳入标准，以促进该患者群体的最佳预后。
